Chronic Kidney Failure in Dogs Community
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My 7yr old Shi-tzu has kidney failure, I have lots of questions

When I had Oscars blood work done the first time his bun was 39, and creatinine 1.7. The vet put him on hills k/d and suggested azodyl, so I started both along with epakitin (the vet did not recommend epakitin) I started that on my own after I read online it was good to use both together.
The latest blood work his bun was 33, and creatinine 2.2. I asked about the epakitin and he said it is not necessary till the phosphorus is high, but to keep giving him azodyl. He also sent me home with sub-q fluids, 110ml every other day. My Oscar acts like a normal happy dog but he does have a few symptoms. He pees a lot at a time and is not drinking as much water. He gags sometimes and has threw up a couple of times. Also when it's time to eat, I have to mix my other dogs food with the k/d  (organic castor&pollux grain free) to get him to eat. I recently am adding tripett green tripe to his food.

My first question is about the green tripe, at the levels Oscars are, it a good idea to feed it to him?
I have read raw food or making your dogs meals is better then prescription diet. What is your opinion/experience?
I also usually work five days a week, so it would be hard but I read 3-4 small meals a day is better?

What is your opinion/experience with azodyl and epakitin? What would you recommend?

I thought about starting Oscar on the canine kidney health program by five leaf pet botanicals. Has anyone had a good experience with that?

Also what about pet wellbeing kidney support for dogs?

What probiotics would you recommend?

What are your thoughts on slippery elm powder for nausea? And activated charcoal for detox?

Which is better water spring, distilled or purified?

What omega 3 would you recommend?

As you can see I'm worried sick and have been doing a lot of research online and not really sure what route to take. I just know I have to do something and want to feel like I'm doing everything possible to give my little Oscar a chance to get ahead of this horrible disease. Thank you

1 Responses
1916673 tn?1420236870
Hello. Welcome to our family of friends here. You have come to the right place. I am going to attempt to answer all of your questions, so this may be a long post - you might be better printing it out and reading it a couple of times, as some answers are quite complex. In addition, I need to reply in several posts, because of the text limitations by MedHelp for single posts. It is hard researching canine kidney disease and getting the right answers from the internet. A lot of information is misleading, because it originates from hearsay or product suppliers who are just out to sell you something whether it actually works or not; other information is very old and outdated; and even more is anecdotal, without any proof-of-useful studies to back up the claims made.
First, let's deal with phosphorus and phosphate binders ...

Your vet is wrong to say they aren't needed until phosphorus is high. This is outdated advice. In fact, the best results in getting phosphorus levels down and under control are obtained from giving a phosphate binder just before phosphorus blood levels step into the abnormal zone and when phosphorus is seen to be climbing consistently over the last 2 or 3 blood checks.

If you wish to challenge your vet on this, please read my article on it at:


and you will then know more than your vet does, or so it seems. My preference for a good binder is aluminium hydroxide, which you might want to bear in mind. Importantly, you don't mention what the current phosphorus level of your dog is from the recent blood test? Please let me know.
Next, let's look at Epakitin ...

This really is pretty useless, although it does have a small benefit. Rather than being a phosphate binder, it's really little more than a nourishment supplement, having very little phosphate binding ability in it (despite the claims made in some articles). In fact, the manufacturer has recently had to amend their publicity material due to advertising standard rules, because their prior claim of it having phosphate binding ability was so proved to be very misleading. There is also another problem with Epakitin ... it is mostly used for cats not dogs, and is chitosan-based. The content is 8% crab and shrimp shell extract, 10% calcium carbonate, and 82% lactose. Firstly, most dogs are lactose intolerant, so that alone could cause problems. Next, the high emphasis on calcium from the shell extracts could cause hypercalcaemia - something you definitely want to avoid.
Next, let's talk about Azodyl ...

Azodyl is a mixture of probiotic organisms and prebiotic therapeutic supplements for dogs at varying stages of kidney failure. The manufacturer says it uses a mixture of three urease positive bacteria that work to actively reduce toxins in the bowel and circulatory system. Various studies have assessed how effective Azodyl is in treating chronic kidney failure, with most coming to disappointing conclusions. David J. Polzin, DVM, PhD, DACVIM, undertook a comprehensive research project (compared against others) in which 32 dogs with moderate renal failure were randomly given either Azodyl or a placebo. These dogs were later evaluated on their blood result levels, body condition and owner perception of quality of life.

Unfortunately, there were no significant differences between either group by the end of the research project. At the very best, this and other theoretical and in vitro study results suggests probiotic therapy might augment a 10% - 20% decrease in blood work markers of renal failure. In turn, this could be enough to affect clinical symptoms and the course of the disease – or not. Dog owners grasping around for anything that could promote positive change might consider these conclusions are encouraging enough to try Azodyl. I have spoken with many owners that firmly believe it has helped their dogs, despite the wholly inadequate scientific evidence to back-up such claims.

Azodyl should only be administered in capsule form, as any other delivery system will not allow it to reach the gut intact. Dog owners should also note that antibiotics are known to destroy the active ingredients contained in this product, so don't bother giving Azodyl until antibiotic treatment has finished.
Next, let's look at Green Tripe ...

I personally think green tripe is an excellent source of nourishment for kidney disease (kd) dogs. But, only as an appetiser or occasional meal. Why? Because it is rich in fat, which can lead to pancreatitis if it's given excessively or as a main and regular meal over multiple days or weeks. Much also depends on the source of the green tripe. Personally, here in the UK, I only use natural organic green tripe - so I know the animals it came from did not die from illness or were given medications and/or antibiotics, which would all end up being part of the product (with disastrous consequences for kd dogs eating it).

Next, let's look at diet in general ...

The Hills kd (canned) is a good source of food for a kd dog. It will help keep phosphorus intake restricted and it contains 80% water (good for hydration and flushing out toxins). It also contains high quality protein, rather than the low-quality protein contained in most dog food products. For now, the Hills is the right food for your dog and although Oscar may start to turn his nose up at it (many kd dogs start to get very picky with food), it would be good to use the green tripe in small amounts to improve the taste - and you can also try drizzling a teaspoon of organic honey on the top as an alternative appetiser.

If Oscar starts to refuse all food, get your vet to prescribe Mirtazipine, which has some positive benefits in dealing with nausea, inappetence and vomiting.

Feeding the appropriate daily amount of food for your dog's breed - but in up to 6 smaller meals during the day, is the right way to go. This helps reduce stress on the kidneys, as they don't have to try as hard to deal with all the by-products and toxins from one larger meal.

Raw feeding is good for kd dogs. But there are huge problems in achieving this, because so much depends on where the raw food has come from, how the animals have died, and it is equally important to get the mixture of tissue, organ, etc., absolutely right. In addition, dogs that have not been brought up on raw food tend to have problems digesting it - and it can cause both diarrhoea and vomiting to become a big problem. For kd dogs, both these symptoms are harrowing, as they already feel unwell from the kidney disease - but in addition, the symptoms also cause them to become dehydrated, which can be fatal.

Have a read of my article on raw feeding here, as it goes into it in much more details:

Various kidney support supplements make vast and unsupported claims about how they help dogs with the disease. My own opinion is that while they are unlikely to help that much, they are also unlikely to do much harm.

Slippery Elm is something I know much more about ...

Slippery Elm is a herb that is widely considered helpful to both dogs and humans in different ways. It is useful for those with digestive problems, as it contains mucilage and tannins that act as demulcent, emollient, protectorant, and astringent. These help bring relief to sensitive or inflamed mucous membrane linings of the digestive tract and bowels. While it is not a cure for the primary condition and there are no studies proving any beneficial effect on dogs, there is some evidence in humans suggesting it acts to soothe gastric problems (including ulceration and inflammation) and improves the symptoms of constipation and diarrhea.

It is also said to relieve some respiratory problems, as its lubricating qualities seem to ease coughing and some bronchitic symptoms. There are claims made by some product manufacturers that it helps treat urinary tract infections, but there is no evidence to support this use.

Slippery Elm is a mild form of treatment and it is not known to cause any health concerns. In some more organic forms, the bark can cause allergic reactions in some people (and presumably in some dogs as well). There is a known risk of abortion in pregnant dogs and it is thought to interfere with some standard medications, so it is important to get veterinary approval is before using. Like many other holistic remedies, there is a lack of reliable research into the benefits of this herb on dogs and – as far as I know – there are no studies whatsoever to prove any beneficial effect on dogs suffering from kidney failure.
Next let's look at probiotics ...

There are lots of claims made about probiotics and how they theoretically help in chronic kidney failure. Unfortunately, there are absolutely no claims substantiated by reliable research. Mark Crislip MD put it best when he said:

‘We understand very little about the important and complex ecology of the gastrointestinal tract, about what bugs are there and what they do for or to us. So while the idea of influencing this flora to restore or support health makes some sense, adding a few Lactobacillus to the mix and expecting it to have a major effect seems a bit like tossing a few grass seeds into the Amazon rain forest and expecting a golf course to grow there.’

The claim commonly made is that probiotics help break down the byproducts of digestion that  help cause uremia, which in turn produces high creatinine and BUN levels. Backing up this claim are some small and unreliable studies, usually financed or conducted by specific probiotic companies. Influentially, there are thousands of dog owners that have offered anecdotal evidence about their dogs improving after being given probiotic supplements.

Perhaps a major problem with all probiotics is ensuring the microbacteria remain alive by the time they reach the intestine .. most if not all are killed off by stomach acid, making their use and value somewhat hit and miss.

So, what supplements would I recommend ...

CoQ10 has certainly some evidence of helping kd dogs. So too has Rehmannia 6 or 8. Vitamin C (in the form of ascorbic acid) does little to help the kidneys directly, but it does help correct the loss of this vitamin through increased thirst and fluid therapy and consequential frequent urinating. Excessive amounts of Vitamin C can cause stomach upset and diarrhea, so it is best to postpone giving it if these symptoms present themselves. Coconut oil (pure) has some interesting properties. It’s rich in beneficial fats but low in vitamin D. Vitamin D is difficult for the kidneys to deal with, so this particular supplement reduces stress on the kidneys while still getting essential fats into the system.

Milk Thistle helps to support the liver more than the kidneys, but as the kidneys deteriorate, the liver can be adversely affected because more and more toxins tend to have to be dealt with by this organ. I would certainly consider this as a useful addition.

Rice bran is what remains as a bi-product of turning brown rice into white rice. It is very nutritious and abundant in vitamins B1, B3 and B6, iron, manganese, selenium, magnesium and omega-3 oils, as well as health-promoting natural antioxidants and fiber. Rice bran is also one way to help a dog gain weight when it has started to lose it through kidney failure. Moreover, rice bran is a valuable fermentable fiber, which can help with the process of excreting harmful and toxic urea. Urea (a nitrogen-rich waste product) is normally processed by the kidneys, but when the kidneys cannot undertake this job, it builds up and increases the level of toxins circulating in the blood (uraemia).
Omega-3 is perhaps one of the most important supplements. It's important to get the mix of omega-3 and omega-6 right, because too much omega-6 can be damaging to kidney disease. These fatty acids are in many food products, and while omega-3 is either absorbed or excreted (as it can't be stored in the canine body), omega-6 cannot be readily excreted, so it builds up. But the two fatty acids work together too, so if the balance is right, one will kepp control of the other. So, omega-3 is good at keeping control of omega-6. The best source of omega-3 is pure organic salmon oil. This must be given in the appropriate quantity (too much ould be avoided) - and you must give a canine Vitamin E capsulre every time you give salmon oil, because fish oils deplete vitamin E in the canine body.

Finally, let's talk about water ...

I would try to fill the dog bowl with filtered bottled water only, as this retains some useful minerals while has all the bad toxic substances removed. Purified and distilled water has no minerals at all - and tap water is the worst, as it has lots of impurities, bad minerals including both flouride and sodium.

I think that's enough for you to absorb for now.

Let me know how you go on taking all this in - and applying it - and then get back and let me know if you have any more questions.

Good luck.

Always something I miss ... two things, actually ... first, has your vet performed a blood pressure check? If not, it needs doing. High blood pressure is very common in kd dogs and causes a rapid deterioration in kidney function.

Second, a useful natural supplement to add to your list is cooked green cabbage. Just a desertspoon mixed into food every 2nd or 3rd day will help prevent ulcers forming in the stomach (another common symptom in kd) and it will introduce some fermented fibre to the diet too, which is beneficial.

Hi Tony, thank you so much for your response and taking the time to answer my questions. I have requested the thorough blood work results from my vet. I will let you know when I receive them.

I wanted to know what you thought about giving him activated charcoal?

And by filtered water, would spring water be a good choice?

Oh and by antibiotics, were you referring to the sub-q fluids? I will stop the azodyl for now If it destroys the ingredients.

I'm also not able to feed six small meals a day because of my work schedule. Thank goodness Oscar is still eating, although sometimes reluctantly. For now he gets morning and evening feelings. It really does help to introduce new toppers to his meals. Are cottage cheese, egg whites or plain yogurt good toppers as well?

We adopted Oscar from a high kill shelter. He is such a sweet happy dog. I wanted to get him checked out to make sure all is well. I was shocked to hear about his kidney disease. I thought he was healthy and just a picky eater. Im really trying to do all I can for him and keep him feeling good. I just hope I'm doing it right!
Thank you again for your help, I really appreciate it!

Hi. No the SubQ fluids aren't antibiotics. I always mention antibiotics when giving Azodyl, because many kd dogs get UTIs (urinary tract infections) and end up having to have antibiotics. Azodyl is so expensive, it's pointless wasting it when a dog is receiving antibiotics.

I can't really comment about Spring Water, as so much depends where it has come from and what's in it. Spring Water is sometimes not as "clean" as filtered and can even include traces of pesticides. If however it's spring water designed for humans, it will give a full breakdown of what is in it on the label. So just check carefully so as to avoid things like chlorines and sodium.

Very small amounts of cottage cheese are okay (like maybe a teaspoon). Egg whites are a good source of protein, but no more than one or two a week. Yogurt (plain and unsweetened) is usually okay, but do look out that it doesn't contain xylitol, which is an artificial sweetener toxic to dogs).

I'm not sure about activated charcoal ... it's not a supplement I have used and haven't looked into it's beneficial or adverse qualities.

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